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Important Aspects of the Public Structure: Medicare and Medicaid
Public Health care services in the United States are funded by the government; they are a mixture of federal, state, local, and private sources of funding. Every year the financing differs due to proposed budgets and expectations and decisions made on the federal, state, and local level. There are different avenues of obtaining health care coverage in the United States (Woof, L. Y. Aron, Woolf, L. Aron, 2013). The public sources are Medicare, Medicare, and the Veterans Health Administration (Woof et al., 2013). An essential factor to these public health forms is affected by the Affordable Care Act that was signed in 2010. When we think about medical insurance, something that always comes to mind is Medicare and Medicaid. Medicare was developed in 1965 through the Medicare law in an aim to provide national health insurance to people 65 years of age and older (Bodenheimer & Grumbach, 2016). Medicare is government-funded meaning when someone who is covered under these programs requires medical care, the government pays the health care provider based on their set rates decreasing inflation of costs (Bodenheimer & Grumbach, 2016). According to the data presented in Bodenheimer and Grumbach, in 2014, fifty-two million Americans were enrolled in Medicare, and fifty-one million were enrolled in Medicaid (2016). Although Medicare and Medicaid have changed throughout the years to balance cost control measures, and national health expenditures it still delivers care at a lower cost to the public aiming to provide them with affordable care options (Bodenheimer & Grumbach, 2016). Medicare is financed through different avenues such as social security, federal taxes, and premiums paid by the individual at an affordable price (Bodenheimer & Grumbach, 2016). Essential aspects of Medicare are that it is a social insurance program and to be enrolled the person must have made social security contributions for 10 years minimum to gain eligibility and receive health benefits (Bodenheimer & Grumbach, 2016). Those that reach the age of 65, who are eligible to receive social security and their spouse are eligible to be enrolled in Medicare Part A at no cost (Bodenheimer & Grumbach, 2016). Those not eligible for social security can enroll for Medicare Part A for a monthly charge (Bodenheimer & Grumbach, 2016). Medicare covers all health-related needs, such as hospitalizations, nursing facilities, home health care, and Hospice (Bodenheimer & Grumbach, 2016). Those who chose to further enroll in Medicare Part B have coverage for additional medical expenses, different therapies, medical equipment, laboratory services, preventative care, medications, and medical assist devices such as hearing aids, glasses (Bodenheimer & Grumbach, 2016). A new addition that joined Medicare in 2003 as a part of the Medicare modernization act named Medicare part C and Part D (Bodenheimer & Grumbach, 2016). Medicare part C is provided by private insurance and allows the same benefits of Part B and additional adjuncts such as routine checkups, and health promotion resources such as exercise classes (Bodenheimer & Grumbach, 2016). It is still government funded, but the enrollee would pay the private health plan instead of the specific fee to the government (Bodenheimer & Grumbach, 2016). Although there are some contingencies with Part C such as being able to see certain doctors covered under the specific enrolled plan and limitations of other pharmacies, dentists, etc., it still an affordable health care plan (Bodenheimer & Grumbach, 2016). Medicare part D is a paid prescription drug plan that covers a segment of prescription drugs cost and is financed through tax revenues (Bodenheimer & Grumbach, 2016). Medicare part D has different programs that include different medications and has separate deductibles, premiums, and coinsurance payments. It is covered through individualized companies that cover the costs directly and retrieve funding from the government after (Bodenheimer & Grumbach, 2016). There are still several kinks in the Medicare Part D program due to gaps in coverage, issues of distribution through private companies vs. the government, and a no negotiation cost of the price of medications (Bodenheimer & Grumbach, 2016). These issues have left much confusion and increase in value for those distributing the plans, subscribing to it, and billing it (Bodenheimer & Grumbach, 2016). So it is safe to safe that the Medicare Part D program still requires a little review. Medicaid was developed to provide medical insurance to the population with a low income, those requiring public assistance and those that met specific criteria such as being a young child, pregnant, elderly or disabled (Bodenheimer & Grumbach, 2016). It is funded by federal and state taxes (Bodenheimer & Grumbach, 2016). The individual does not have any social security input to be eligible to receive Medicaid. Medicaid is funded 50 % from the state and 50% from federal taxes revenues (Bodenheimer & Grumbach, 2016). It is eligible for all legal residents with a family income below the federal poverty line of $ 16 000 (Bodenheimer & Grumbach, 2016). Medicaid has changed over the years, and under the Affordable care act in 2015 now varies between states on coverage criteria and conditions (Bodenheimer & Grumbach, 2016). References Bodenheimer, T. S. & Grumbach, K. (2016). Understanding health policy: A clinical approach (7th ed.). New York: McGraw Hill Woolf, S. H., Aron, L. Y., Woolf, S. H., & Aron, L. (2013). U.S. Health in International Perspective: Shorter Lives, Poorer Health. National Academies Press.